Tinstmaw, George This "Stub" to be kept by person issuing Permit.
BURIAL PERMIT
1. Name of Deceased__. A!.-I! .....
—--—------- ---—---------- ------------ ------------------
Sex.."f.... ----------------
2. Place of Burial... ------- ----------
8. Date and Place of Death---- a---—V�---------
-----------------------1----
Cause of Death.—I-1.1 ..............
---------- ...... ....... ........
5. Certified by....'JnAdi-,...(.::�
........................
-----------------------—--------------------------------------------------M. D.
6. Undertaker...
Sold by C. E. HouGHTALING,Law B1aak Pabiisber,Albany,N. Y.
•
`.. ST AT Ei O F W EW YO RK. Form 5%
b�
. BURIAL PERMIT.
.d m.11.1
Oy^ -
a ,°«7 o Name of Town _ -23I_C,!_1. GJ 12j,'(,��,A
o JJ t (7S
a e`e +' j(Village) and County(1-
x ; 1 g ___ _-_._-....(Dated,) ! 6 19 44.
U v The Certificate of Death having been furnished to me, as required by the Laws of this State,
Z §'aC
n (. z Cd permission is hereby given for the Burial of '- ct- tRr� v
x E
0 0 0�
�c,9 p _ (City or Township)
a : v Sex Wt .�t. Age 4__.`1 who died at
at y 1 , in the
IA a$a County of Ill__AL. -e-t-t. n ( ,,�,a — 19/G the cause
x ? d o E of death being-_e- - _ V v Place of Burial _ ,(
V v
4 y Undertaker or person t Cf, ,� y�,_ (Signed by)_
o c a y in charge of Burial,
'• )13 ^ a Residence �!'�� ¢ `L n ' • (ovsx) ���„,....c-- �s�rti�` C i
— - (Official Title) —